The Final Solution

Solid Ground and the Rescue Line

Peer specialists risk getting bit in the ass. If it is not the illness, it is the people we are supposed to be helping. How much do we disclose to them? What is the limit on honesty and openness?

I disclosed early on in my career. I just could not be bothered hiding the fact that I was just as “out there” as the people I helped. The difference was that I had gone through training and learned how to live with the “normals”. I knew how to talk with them. I competed with them on their academic turf. In short, I straddled both worlds. They were sometimes howling in the hospitals, other times having drinks and finger food with the boss.

My first time having my diagnosis shoved in my face was with a woman in one of my groups.

Everyone knows you have problems
EMB

Peer workers work in two dimensions. On the one hand, peers get paid to use their experience effectively with the clients. On the other hand, they go home to live somewhat marginalized and jeopardized by the illness. If not correctly put in its place, the insidious, dangerous condition threatens to wreak havoc with hard-won economic, social, and psychological gains.

I supervised peer interns from Howie the Harp. For the most part, they were terrific. I met my match, however, in a wild little devil that insisted on reporting me as unfit because I had told her to comb her hair and button her shirt. Luckily, the staff had my back.

I had had enough. The next intern insisted on going over my head to the director and workers she considered more competent because they weren’t peers like I was. So I went offline and waited for her internship out in the psych spa. I came back when she was gone and told my director I was through supervising peer interns. I knew my limits.

Peer workers are people who somehow pull themselves out of a hole. Now they stand on solid ground and throw a rescue line down into the abyss. Jealousy, resentment, and rage get in the way.

No matter. It is a crazy happy day in the neighborhood, and no one is going to mess with my high!

The Communication and Support That Allows Progress in Treatment

To make progress in life, maintaining a presence in mental health treatment is needed for many people. Personally, I know there are barriers to maintaining a presence in treatment. The goals of a practitioner and someone receiving treatment do not always coincide. It is interesting to determine at what point the purposes of the consumer and practitioner intersect. I know that treatment is beneficial in my life, but communication has become very difficult with service providers. For this reason, support needs to be established with common goals in a therapeutic alliance.

Goal setting in treatment may be one way to establish a common ground and language. However, varying temperaments in a therapeutic relationship will slow the road to meaningful therapeutic gains. There are inevitable conflicts, with baggage on both sides hindering real productive communication and goal setting. Ironically, sometimes it is the practitioner that carries more weight and credence to drive treatment forward. Objectivity is difficult whenever people and perception are involved, as everyone has the best idea.

All too often, treatment gets disrupted, many times, without warning and naturally throughout care. When progress and accurate work in treatment unravel, establishing or resetting a goal and kickstarting the momentum of the work is almost impossible without a social worker communicating the clinical play by play when cases have robust moving parts. When personal ambitions interfere with goals, it also may be challenging to maintain the ethical reins to keep treatment smoothly and without incident.

In fact, specific measures such as more extended unnecessary hospital stays could be avoided in some cases with better communication from the treatment team. Certain attitudes by social workers may exacerbate symptoms rather than give relief when a clinician takes cues from the wrong parties or isn’t truly engaged in their work enough to be a real changemaker and cheerleader in their client care.

All too often, patients are triggered by treatment providers without empathy. These feelings can lead to an ‘episode’ or the unraveling of a patient’s progress to date. Sometimes, these clinical missteps are so critical and negligent they make further treatment and additional clinical services necessary. With proper caution executed, and good listening with precise language, treatment progress can be maintained and preserved during touch-and-go blips that arise during care provision.

With a well-seasoned treatment team, enrollment and selection of programs and tandem services after discharge can be successful for many years. In the end, treatment at one level of care cannot go on or be maintained indefinitely. With time, everything changes, and someone may show the most signs of relapse when significant progress is being made.

For this reason, identifying valuable resources for patient education is critical for long-term progress after discharge and incredible natural support for patients to draw from when other artificial supports are inaccessible. Some supports need to be titrated down for the well-being of the consumer. When someone craves independence, but their goals are being withheld, severe conflict may worsen psychotic symptoms.

In cases of serious conflict, the proper change may be medication, but there may be more going on in the environment, or socially that can ease the episode. Changes in both may be needed, but good communication and appropriate support can certainly help to calm an attack.

In the end, the nature of life is dynamic, mental health treatment should be regarded as such. If life becomes stagnant due to failure to understand the needs of someone, symptoms can flare up. In worst-case scenarios, prison may be an outcome. However, communication and support are more attainable with grasping the history of someone. Responses will be more appropriate, and crises can be avoided with a reasonable, empathetic method of questioning.

RESPONDING TO A MENTAL HEALTH CRISIS: WHO IS THE MOST QUALIFIED?

The ongoing spirited conversation about emergency mental health reform and community response protocol is getting tired. When I say exhausted, I mean it is about time we reach a consensus.

Today, and I’ve said it before, we stand at an impasse—the boiling point of new reform just around the bend.

The issue that hinges on the docket today is Emergency Mental Health. More specifically, crisis intervention, crisis calls, 911 mental health dispatches, and other emergent mental health crises in the community.

I am so fearful that this process (the legislative process that dictates the provision, execution, and law, how it is defined and carried out, etc.) will get hijacked and derailed. We advocates must focus on how all this talk will translate into a workable framework for handling emergency mental health interventions.

This subject has only gotten more controversial over the last few years. In my opinion, the rift between advocates and lawmakers, and mental health professionals have more to do with the definition of response than with how to handle the implementation of theory and practice in the field when responding to a real crisis. This is because definitions vary across disciplines, state lines, and mental health professionals.

With the reinvigoration of social justice issues plaguing our country, this issue will only get more attention. As our society reevaluates the intersections of disability, mental health, and social inequity, we can be sure the ‘spirited’ nature of this debate will drone on and on without an answer. I only hope all the enthusiasm is put to good use. Hopefully, some of this good use will be through this blog article and real productive debate and reform will come.

For the same reason, advocates argue with each other. Passionate people from all walks of life don’t always agree with the way things are in society or should change in the future.

But is that true with this conversation? Specifically, why are we still at odds? Why haven’t we reached a consensus and passed the debate phase of how this talk will translate into the new policy. When are we going to reform the way crisis intervention works in the community?

Probably, when more definition is laid out around ‘crisis’. I am a social worker. I am also a person with lived experience. I can tell you that what is a crisis for one person, may look totally different than for another person, even with the same disorder or problem, or diagnosis. Now, imagine, two people are presentation totally differently and then add in location (city versus rural), context (domestic situation), etc., etc. My point is that every situation is different, even for ‘mental health crisis in the community. Therefore, it is so hard to come up with a protocol for each situation and how to train and educate responders is so complex and needed, and urgent.

Without a consensus at the level of language, ‘camps’ have formed. Experts are divided on which mental health professional (e.g., psych nurse, social worker, peer advocate, psychiatrist, paramedic, etc.) and intervention strategy is best equipped to respond to emergency mental health ‘crises’ in the community.

Right now, as it stands today, there are several approaches, both programmatic, and stylistic, depending on the professional bend of the worker and his or her education, training, and experience practicing.

In terms of programs, some do a prescreen. Programs will screen people in crisis ahead of time either through a provider that calls out of concern or through the person in crisis calling to self-refer themselves in lieu of going to the ER or calling 911.

This sort of ‘soft landing’ in the mental health system is what NYC and other cities are now doing to divert traffic to ER’s and other mental health crisis triage centers across the country. They also act as a hospital diversion competent to systems where hospital beds are short and in cases that are more social than psychiatric which the hospital is an impropriate fit.

I learned much about what it means to be in crisis, and about the systems in place to address them as a social worker, and as a peer advocate. While I don’t think social workers make great first responders in some crisis situations, I think peers make even less of a fit in these situations. Certainly, social workers do not belong going into homes where there is the additional risk of violence without other, auxiliary professionals present.

Social workers need to be part of a larger community response. But right now, the system is limited.

When it comes to fulfilling the vision of community response there are few options after ER rooms and the few cities with limited and overextended crisis response teams assisting folks in crisis to a softer landing in the system.

When it comes to sending in a wide network of collaterals, organic, paid, and specialized personal, right now, ACT Teams and the CAHOOTS model are the nation’s front runners.

ACT, CAHOOTS, and other interdisciplinary teams) utilize prescreening methods, and go out on crisis interventions with folks already enrolled and in treatment on their census.

For people in crisis and not already on the census of an ACT or CAHOOTS team are new to the systems radar. These folks who are off the systems radar may present a degree and risk of violence to a crisis response team.

Even less clinically prudent, there are crisis’s and no prescreen mechanisms in place to the hand of clinical information to team responding in the community. Talk about a double-blind nightmare. This is also the reality of clinicians every day who respond to mental health calls in the community without enough data to safely handle crisis intervention.

In the end, more work, education, and training need to be invested in the social work education and clinical training before social workers should walk into potentially threatening environments without other seasoned responders.

My recommendation, which is already beginning to become a reality, is to have police and social workers working side by side. Right down the setup of the police station itself, these social workers can be regular members of the police force and community to cross-pollinate intervention strategies with the prescient and its staff.

For nonthreatening interventions, in many states, including my home state of New York, and the county of Westchester, ACT Teams call the local police department for every emergency crisis intervention for patients on their census. In other states out west, CAHOOTS teams respond to non-threatening situations, and even act as a mobile hospital diversion team for many homeless, and substance abuse related issues. CAHOOTS is known to respond to folks that aren’t even on their roster or are new the mental health system.

When it comes to ‘crisis’ response, the readiness and effectiveness of crisis intervention will require more education, practice time, and to a lesser extent, additional training for all field workers.

In social work, the Social Work Accreditation Boards, the ASWB: Association of Social Work Boards and other regulatory bodies credential and assess content areas’ rigor in disciplines of education and curriculum. A lot more is lacking but let us start somewhere. Curriculums needs to bridge an academic understanding of what it means to be in ‘crises. We can start with arming peers interested in doing this work with real skills and interventions beyond Social Work 101. I am afraid learning ‘Motivational interviewing’, and basic de-escalation strategies is not a sufficient skillset to take on emergency response calls.

We also need to think about what practice means given the current state regulatory instruments already established for determining if which of these disciplines, IF ANY, are ready and competent to perform the crisis work. The heart of my recommendation is to advance both the curriculum of the peer workforce and practicum towards readiness in crisis intervention AND social work education in addressing violence and safety issues in threatening environments.

What would this look like, and how can states, and local agencies roll it out? One pathway forward, on the level of education and practice, is to require peer internships to have a much more elaborate and specific crisis intervention component beyond what is currently offered as a tandem or extra component to their certification. In my opinion, the current broad ‘forensic’ certification, simply isn’t enough when we are talking about peers going into potentially dangerous environments alongside with police.

This just seems like a terrible plan. Before we make a big mistake and prematurely throw both peers and social workers in precarious situations where there can be the potential loss of life, why not pause and reevaluate these aspects of the peer education and social work intervention first? In the very least, lets agree what a crisis is before we intervene in one.

Going to Social Work school with a Schizophrenia diagnosis

Everyone needs to dream big in life. Goals are the waypoints to those dreams. It was always my goal to go to graduate school. After my ‘break’ from first-episode psychosis in undergraduate school, my goal to graduate school was on the brink of failure. My goal was so important to me that I was uncompromising in my recovery to heal and move on with my life. When goals are critical to us, people will do everything in their power to reach them despite the obstacles in their path.

My obstacle was my schizophrenia diagnosis and the residual symptoms that medication didn’t manage. These obstacles didn’t stop me from applying to a social work program two years later when I finally reached my goal of enrolling in a graduate program. Because I was marked as ‘sick’ and mistreated due to revealing my psychiatric history earlier on in my education, I kept my mental health issues to myself in graduate school.

Aside from my girlfriend, a few close classmates in my cohort, and the people who already knew my schizophrenia diagnosis, I kept my mental health to myself. Not sharing and being utterly private about my mental health history meant a few things:

I would have to be ultra-careful about managing my schizophrenia symptoms.
Be mindful of blips or changes (however minor) in my mental status so faculty and other students would not liken the lability to a possible mental health disorder.
Be very careful about who I confide in about my history to avoid information falling into the wrong hands or people that might be stigmatizing and discriminatory.

There were times when I could do it all, be mindful, careful about disclosing, and super self-aware without incident. Other times, I found it more difficult to hide who I was and my history as a person with lived experience. When I was happy, content, and not very stressed, being mindful of all of these aspects of being secret about my identity was easy. When there was an exam or a vital essay due, I found myself becoming sad and pensive. It was during these stressful times that I got angry and self-loathing. I became upset about my history and how I was less than completely authentic about who I was and my past.

Graduate school in social work has a big self-reflection piece. One of our educational goals is to become more self-aware of our ‘stuff’. Together, in class, we unpack the microaggressions and discrimination we’ve internalized our entire life. Meaning, we learn why how our perception is shaped by the societal apparatuses which inform our everyday mindset and way of interacting with our peers and family. So, when this aspect of graduate school came around, and it was my time to reflect and learn about myself, I knew I would have to be very careful about how I went about this process.

I didn’t have the option. I could not openly reflect on my past because I had chosen to keep that piece of me a secret. I could make up a past and reflect on a fictitious history to practice the art of telling a compelling yarn. For a while, this is what I did. At first, it seemed phony. The content of the stories I spoke about my past were all made-up lies. I made up some outrageous stories. When it came to writing my autobiography, an exercise we all had to do, I was left with the creative freedom to enmesh my history into an outrageous, downright hysterical backdrop. Other students laughed when I told these stories, and they were so artfully crafted and congruent with social work theories of human development the professor couldn’t deduct points.

I was relentless about lying when I needed to defend my history. But when it came to being honest, and opportunities presented themselves to be me without any of the phoninesses, I made the most out of it each time. I was brutally honest, so honest. It almost seemed to align with the phony storylines I created earlier on. I still remember a professor talking to us about our dreams to motivate us and get to know a bit of what we were interested in for the end-of-the-year research project just around the corner. I remember the first few responses. “Getting married, owning a big house, being a social worker of the year…” and so forth. No one was expecting to hear what I was about to say.

“I want to move into assisted living,” I told the class.

My classmates laughed harder than ever. But I was serious this time. They just had no idea why. I was exhausted from being overmedicated and extremely tired from my graduate school program. After all, I was in a state hospital two years before this, and now I was in graduate school and a relationship. It was a lot.

So when it came to my dream in life. It was to finish the program, get my master’s, and move into a setting where the assisted living center took care of my meals and cleaning. I certainly didn’t want to move back in with my parents. They were exhausted from caring for me to this point.

With my master’s in social work and a full-time job, I figured I could pay for an assisted living center to do everything for me. I could then focus on taking care of myself and my reaching my goals. When you are tired and overmedicated, goals seem further away. They might even feel or seem unreachable at times when someone is cooking your meals, cleaning your living space, and basically, managing your ADL’s (Activities of Daily Living). There is more time and energy to focus on goals, a job, and doing everything everyone else does but with some assistance at home.

“What? Max?” Another student said. “You’re kidding, right?” said yet another student. That was when I explained myself. I didn’t disclose my mental health disorder. But I did explain how tired I was a lot and how much time and energy housekeeping can be and absorb. I explained how all this energy could be invested into pursuing my dream career or any goal I set for myself.

When I put it in these terms, ‘energy’ and ‘time,’ suddenly everyone knew what I was talking about with my assisted living response. If I had said my answer was because of a mental health disorder, everyone would have pitied me and felt awful. When I made it about being savvy about how I expended my energy and time, everyone thought I was intelligent, innovative, and so forth. My point is that stigma goes deep, and if people let themselves become blinded by discrimination. Suppose people choose to be more open and nonjudgemental with their thinking. New ways of understanding the world and reaching their dreams might be next.

This is a PRO Tobacco Use Argument in Mental Health Settings

The growing trend in most mental health centers is banning tobacco products and their use on campuses that deliver treatment and other supportive programs.

This trend defies the age-old image of ‘mentally ill’ folks pacing around outside their treatment center or a hospital smoking like chimneys. What is the result and impact of these bans on the folks in my image?

When I first entered the mental health system in 2003, I was an adolescent in an inpatient unit in New York State, and smoking was already banned for adolescents. After all, you would be hard-pressed to find a smoking section in a restaurant anymore. Adults still could smoke, but only in certain restricted areas and at certain times.

Before the banning, adolescents could smoke outside the building when they were granted outdoor privileges, similar to adults. The rationale, staff told me at the time, were minors weren’t allowed to purchase cigarettes in the community. They shouldn’t be smoking in the hospital.

I accepted with a giant grain of salt. After all, I was a smoker, irritable, but appreciative enough of logic in a place and time where reason wasn’t readily available.

However, when I was hospitalized in the New York State Psychiatric Center in upstate New York a mere five years later, smoking was banned for all patients, staff, and visitors on the hospital campus. At this point in my inpatient career, I drew a line in the sand and took issue.

As an adult in the hospital, I wasn’t just agitated. I was dysregulated, manic, and psychotic. I needed something to self-soothe, and meds and therapy were not cutting it.

Given how bewildered, uncomfortable, and upset I was back from new active schizophrenia symptoms, I couldn’t understand why I wasn’t allowed to smoke cigarettes.

I needed relief and quickly. To be even blunter, I needed a cigarette.

My theory about smoking in the hospital is straightforward. My idea is also within the margins of psychology and elementary logic. When a person is so far from a baseline that all previously learned coping skills don’t work anymore, why deny people the use of their existing mechanisms for finding relief in the most challenging moments of perhaps their life? Why take away the only coping skill that has been working to date? Why must we throw additional barriers in someone’s way to deescalating and finding a moment of peace in a disordered mindset when someone is so sick?

I understand the need and push to ban tobacco use in community health settings. Sure, teach people to access coping skills free of tar, toxins, and health-compromising chemicals. Instead, we need people to learn how to lean on healthier supports and access community resources. In this vein, I am not suggesting pushing cigarette smoking on people who do not already smoke. We certainly cannot allow tobacco companies to come into the hospital and hand out products to vulnerable people and get them addicted to another chemical they will need to manage moving forward discharge.

However, for people with existing habits and already smoke. Why limit, restrict, and agitate these folks further when they could be enjoying a smoke outside like at their own home and maybe feel the impetus to work towards discharge to do just that.

People at the out-patient level are more likely to use other coping mechanisms to find relief instead of smoking or waiting until they get back home at the end of their session or program. Still requiring research is the threshold, that space where the risks of smoking outweigh the benefits of non-smoking and wearing a nicotine patch until that is ultimately discontinued, especially for highly disordered, chronic, and comorbid smokers.

In my opinion, this new shift in so-called healthier practices and wellness overlooks a part of human nature, personal freedom, and introductory psychology. Some people with cognitive deficits and symptoms are so intense that learning new skills will not outpace the cravings or pleasure of puffing a cigarette.

These people will not learn new coping skills fast enough to benefit from not smoking and will be even more uncomfortable and agitated during a tremendously already agitating point in their mental health.

When people are pushing freedom and personal choice in treatment, I am genuinely shocked the hospitals were so fast to embrace the smoking ban. I have been so sick that I wouldn’t get out of bed for days at a time. It wasn’t a pill or the promise of deep breathing that motivated me to get out of bed. It was a cigarette and coffee.

When a person is genuinely symptomatic, in terms of coping skills, it is genuinely about going back to the basics and clinging to what works, what you know, and what you feel will make you feel better in the moment. I genuinely hope the hospitals discontinue this movement and revert, at least in part, to an earlier time when life’s pleasures weren’t removed or banned without consent or our choice.

SPECIAL REPORT: Re-thinking ‘Extended Care’ units in State Hospital Centers

Introduction

This presentation is independent of the Office of Mental Health (OMH), the Department of Health (DOH), and other federal commissions that hire researchers on trends in funding and insurance reimbursement. At the crux of it, both sides of the community versus inpatient debate realize the risks and benefits. Patients must be continually evaluated to determine if the treatment given in a state hospital can be safely provided in community settings. A report written by NASMHPD states that in the year 2012 alone, over 40000 patients across the US were hospital networks will just be relics, anachronistic holdovers of the sins of psychiatry. Where the last great psychiatric cathedrals now stand is a carefully laid out and organized system of hospitals. These hospitals continue to symbolize the harm done to an entire population of mental health patients, who were then described as ‘sick’ or ‘mad’. The institutions included treatment rooms in which ‘medical interventionists forced medication, shock treatment and lobotomies upon patients. Even more insidious and covert forms of treatment were also administered, particularly by the most recent abuser, the pharmaceutical companies. This sets the stage for a new level of state psychiatric mistreatment as the 21st century unfolded.

Today, the legacy of state psychiatric centers in the US is being challenged by former patients, psychiatric survivors, and peers, whose goal is to liberate medicine from psychiatry. Still, research funded and disseminated by organizations like the Treatment Advocacy Center (TAC) and other reports which inform the emerging trends in state funding continues to be off the mark. Indeed, forced treatment and assisted outpatient care need to be continuously re-evaluated which could benefit from release from psychiatric hold and deferred recovery due to problems rooted in access and connectivity to care. However, the reports generated by TAC and other advocacy organizations which put ‘treatment’ ahead of the needs and voices of the consumers truly requires more careful consideration on the part of lawmakers and stakeholders making decisions on how day-to-day operations are carried out by practitioners in state-run units than simply blanket appraisal and adoption of their recommendations. These are recommendations that continue to ignore the reality of life on the unit, and condemnation to extended and ‘ongoing’ treatment without consent, and, even worse, effectiveness in avoiding rehospitalization and certainly not expedited discharge to the community.

To fully integrate services and consumers in the network of already available mental health programs, remaining patients in the long-term state psychiatric centers must be discharged and released from the eternal holding pattern to ultimately integrate and help consumers gain access to community resources, and most importantly, to allow them to live among other people outside the gates of the institute on. Therefore, Phase I of the WCT manual for community access will target the release, discharge, and reintegration of patients into the community. Later phases and future the research will target the establishment of reliable systems in which chronic and high-risk patients will have reliable access to services and programmes that will benefit this group in lieu of hospitalization
(Gagani, Gemao, Relojo, & Pilao, 2016).

Access to outpatient services

This plan begins theoretically at the level of local and state governments and municipalities that govern the regulation of mental health treatment: the state mental health authorities, the National Association of State Mental Health Program Directors (NASMHPD), in collaboration with federal agencies, must approve funding for WCTs to infiltrate access state psychiatric hospital operations and systems at all levels that impact discharge planning and community re-integration. In theory, each freestanding unit in all state hospitals will work side-by-side with its assigned WCTs. Social workers, psychiatrists and all inpatient staff charged with the successful discharge of its patients must partner with the WCTs until the final discharge from the hospital in which the final patient re-enters the community. The crux of Phase I is the funding needed to staff the WCTs across the states. Each team will serve as an interdisciplinary reflection of the treatment gaps identified at each hospital’s locale. This meant that prior to each WCT beginning its work in a unit, the hospital will send a memorandum of requirements to the Office of Mental Health, which will inform the make-up of the teams assigned to each hospital and community. Thus, needs related to transportation and rural concerns will be managed by WCTs specializing in the needs of rural communities and their mental health systems. More urban-based communities with complex spatial access issues will be staffed with workers adept at handling the mental health concerns of patients in an urban setting.

The WCTs is a multidisciplinary, mobile field unit, and treatment team operated and regulated by state mental health authorities. Each team will be trained to target chronic diagnoses, relapse prevention, and offer treatment in a flexible, organic, person-centered approach. While the WCT and assertive community treatment (ACT) are similar in composition, in keeping with evidence-based practices (EBP), the potential for the WCT’s positive impact on clients and, in turn, the likelihood for good outcomes could not be more radically different. ACT team meets with clients for a minimum of 15 minutes of face-to-face contact to be able to bill and consider the home visit a session. While sessions usually run longer, as patients typically have errands or complex case management issues or need transportation to medical appointments to and from treatment, or any number of complex case management issues the WCT clinician or peer needs to address in session, 15 minutes alone is simply not enough for patients discharged from state hospital step down unites. In keeping with this premise, the completion of tasks patients typically request help with or just require the attention of the worker to go on and on. There is a laundry list of needs patients have after discharge from the highest level of care. It is immense, overwhelming for clients still symptomatic and clinically determined to be safe, stable, and ready for re-entry into the community.

Integrating into the community is a challenge without a mental health disorder which distorts, complicates, and makes the vast obstacles ahead seem almost insurmountable. At the root of it, these are not clinical issues, but complex case management issues i.e., connection to medical providers, food shopping, obtaining hygiene, and other household products due to transportation issues. Many clients surrender their driver’s licenses prior to admission to the hospital due to legal, or mishap and unfortunate circumstances. In many cases, due to high caseloads, productivity requirements, and other extraneous non-clinical issues, session times are limited, cut short, or only begin to address these serious problems patients struggle with upon re-integrating into the community. So, upon initial integration to the community, WCT sessions will be longer the length to bill for sessions under Article Zero and count the contact as a required visit. Similarly, instead of a minimum of six contacts a month with each client on the census, required monthly contacts should also increase. Simply put, for WCTs to consider the patient enrolled under the care of WCT, sessions should be doubled in length for clinicians and peers to be effective for the upward mobility of a patient’s recovery.

METHODOLOGY

The planning involved for both the ward closure teams and the existent treatment teams in the units surpasses the assessment of the composition of the community. Indeed, ward closure teams will be required to have a full understanding of local existing services in the community and will work side-by-side with treatment teams in the units to identify issues foreseen prior to each discharge. Hence, issues of adherence will be measured against connectivity issues in the communities’ existing healthcare networks. Other issues, such as medical comorbidities, will necessitate ward closure teams to acquire a full understanding of existing health networks that serve clients with complex medical and psychiatric issues and other complex case management services, which freestanding clinics do not traditionally provide. Simply put, WCTs can supply case management services to users dependent on the system of care after discharge from the hospital, and its vast and complicated services. Given the freedom to complete more case management services, while also providing clinical services, and be the primary point person in consumer care, time-consuming and high impact complex care management tasks can be completed without incident, including certification and recertification of benefits to continue all of the medical necessities are completed so services run without interruption.

Under Article Zero, the incentives to learn, either through continuing education, but either way, certified in new treatment modalities which are proven through evidence-based studies to improve the prognosis of chronic patients being discharged from long-term care settings i.e., state hospitals are not just to experience better outcomes for clients, but also build a track record as a practitioner. So, all new and existing treatment teams on the state hospital grounds as well as treating patients discharged from a state-level facility will be required to be versed and certified in peer-supported open dialogue (POD); and cognitive behavioural therapy (CBT) targeting psychosis, delusional disorders, and a range of diagnostic interventions commonly associated with patients with chronic disorders. Thus, diagnostic and public policy stakeholders of health and medicine all suggest ACT or PACT (Programs of Assertive Community Treatment) in some states should be repurposed and selected as the best available discharge plan after graduation from a step-down unit in a state hospital. In addition to being a mobile unit, care managers, and discharge planners for high-risk patients will benefit by beginning treatment within the walls of the hospital, something ACT teams are limited to do, and according to state regulations and programme guides, in New York State, and can only perform tow ‘hospital visits’ per month to bill for, and maintain the client on the team’s census. Thus, in addition to being more versed new EBP, WCTs benefit from operating the same physiological space as patients treatment team on the unit, a length of time which can be determined state to state, but always able to fully operate at two polarities, the highest level of care and conversely, the least restrictive environment possible, that is, within the community. Upon discharge, patients still under the care of extended care, will step down to transitional care units, sometimes called TCU, WCTs can begin their fieldwork inside the hospital unit, and plan to one day complete home visits upon their patients’ successful discharge from the step-down units or TCU inside the facility of care of ACT or PACT, and, under the provision of services for an undetermined, if necessary, permanent team of patients determined by individual state mental health authorities to require its care which is already prescribed by ACT or PACT guidelines for practice across states (Stein & Santos, 1998) and in A Manual for PACT Start-Up (Allness & Knoedler, 1999).

Phase I

Prior to discharge from the hospital, and incongruence with regulations in several states (New York, New Jersey, Connecticut, etc.), discharge planners across all state facilities will have the responsibility of preparing all clinical treatment plans up for review for immediate step down to a lower-level of care. In doing so, the timetable will be set; while in some states, plans are reviewed every six months, others three, regardless of the lifespan of the plan, personnel in the hospital documenting the transition of patients to the community. Thus, discharge planners will begin to put paperwork into place which will follow clients’ records to the treatment teams in the community which will continue care upon re-integration. This means, across longer-term care units, state hospitals will internally reconfigure their units, to prepare for the large volume of clients discharged from the facility. Without question, this will in turn serve remaining patients well who are mandated by the court, and largely the criminally insane. This subgroup of the state hospital system, according to reports written by NASMHPD, are mostly forensic patients, not including sex offenders, which make up a fraction of the entire state mental health system census. I am suggesting by emptying out and closing down long-term units containing non-violent mentally ill patients, all remaining units will be more likely to be less crowded, better staffed with additional funding now less spread across fewer units. This has proven to reduce the likelihood of conflict and reduce safety issues on the unit in which clients who are extremely agitated react, or act out against their peers and other patients.

When this plan goes into effect, all patients will less likely be exposed to violence. With more money to go around, new spaces and units with a lower census, for a more personalized, person-centered, and safer environment will blossom at the state level. The last segment of Phase I is the expansion of state-level step-down units. In various states, including many of the Northeast, Midwest, and West Coast of the US, step-down units are too frequently used to transition patients back to the community. In many state facilities, including GBHC (Greater Binghamton Hospital Center), RPC (Rockland State Psychiatric Center), and several other state hospitals, only one or two transitional units exist. In theory, all patients in extended care and long-term care units will be transferred to the transitional units available in the facility. Upon the patients’ treatment plan, all new plans requiring an update, will in turn determine the potential date patients are transferred from long-term units to TCU. This is the spark that will light the fire that signals to the inpatient treatment team that new patients now require the attention of hospital staff to determine the long- and short-term planning necessary to begin to successfully discharge patients from long-term units to a lower level of care. This lower level of care, specifically the transitional units available in the facility, will then prepare themselves for new admissions internally transferred from all remaining long-term units. Should, give an analysis of the volume of patients being transferred internally, and ultimately discharged from the transitional unit to the community, it is recommended that the immediate allocation of funding to the creation and expansion of transitional step-down units.

Phase II

To achieve the desired goal, the next major step is implementing Phase II which begins just after the assignment of WCTs to respective communities and state psychiatric centres. At this point in the plan, WCTs of new hired personnel, and even those transferred internally, composed of staff from units armed out and closed down after the facilities reconfigure their census and disbursement of the hospitals’ population, patients’ needs prior to, and after discharge. These WCTs will target, and be staffed by people who are able to target and specialise in specific diagnoses and be prepared for less than promising patient prognosis. Upon gaining access to inpatient services, hospital operations will begin working side-by-side with existing hospital staff. Teams will identify all remaining concerns for patients prior to discharge. This will be a process in which patients will work voluntarily with newly instated WCTs and contract to work with treatment teams in the community earmarked for their care at post-discharge.

Thus, all services will be matched with the needs identified by both the long-term and longstanding clinicians assigned to each unit and patient, as well as the newly commissioned closure teams to achieve the primary goal, which is complete access and the integration of all state hospital patients still in long-term care back into the community and the end of institutionalisation forever. To achieve this aim, the plan and each of its phases require not only community support, but also support from stakeholders regarding mental health and public policies, and also the shared goal of creating a society without walls or restrictive barriers for chronic and long-term mental health conditions who are typically assessed and slated for long-term, ongoing, round-the-clock care that a state institution provides. Thus, the vision and scope of this proposed plan and the prospective teams charged with implementing the final solution and ending the era of neo-institutionalization is clear: full community access to and the integration of all community mental health programs as well as the elimination of a level of care that is both dated and obsolete in the context of the full meaning of deinstitutionalization.

Phase III

Studies continue to evidence the positive trend which suggests people, regardless of their precipitating reason for admission to the hospital, who are supported in their discharge from long-term units, eventually transitioned to a lower level of care without incident and provided access to community resources and mental health treatment are much more likely to succeed in the community than patients either clumsily discharged or without adequate planning. Thus, this three-phase plan lays out a comprehensive third phase. In keeping with the assumption, ACT teams continue to furthermore and more empirical evidence of treating the most chronic and at most imminent risk of self-harm or harm to others. WCTs will ultimately prepare their existing census for discharge to ACT teams, the highest level of outpatient care, and the most effective evidence-based modality across the US for treating this population. Therefore, since ACT teams are already existent everywhere a potential patient is awaiting discharge from a TCU in a corresponding state hospital, these ACT teams will absorb the majority of patients discharged from the WCT. The transition of patients to their assigned WCTs will be synchronized, time and documented similarly to ACT treatment planning. Without recreating the wheel for documentation in the field, WCTs will follow the freewheeling, liberal documenting style and manner of capturing the patients’ clinical picture in the most representative and appropriate outpatient service. Since all outpatient mental health services are ultimately tied to coding and congruent billing, WCTs will follow the coding of ACT services. Therefore, the creation of new medical billing questions does not interfere with the speed and necessity of discharge. Thus, ACT teams will be able to replicate the practices and treatment of WCTs, and the continuum of care will be intact from the moment the patient is discharged from the state hospital and fully transitioned back to the community, without anyone falling through the cracks due to insurance, poor planning, or inadequate services after discharge from the hospital.

The end of neo-institutionalization

Mental health is a community of public health needs and after implementing the proposed plan, the fallacies and misnomers of the old system will never again point towards institutionalizing people and sending the ‘problem’ patients to the long-term care units far from the community and its resources. Access to services must be provided and new pathways must be engendered so that consumers can gain access to the many lines of care already provided by the systems of care in New York State and by all regulatory bodies with a vested interest in mental health treatment. Neo-institutionalisation is complex and insidious, and it must end. Therefore, the focus of the ward closure operations manual is threefold. The first phase of operations targets the state psychiatric centers based on a global assessment of outlying communities and on the express needs of the consumers being discharged. The second phase targets the overhaul of treatment silos and installations already in place in the community that needs more integrated access for consumers. Without question, the resources already exist in the community, and this document proposes how to reconfigure existing structures that provide mental health treatment to serve patients. The success of Phase II depends on the elimination of freestanding treatment silos. This means that all treatment programs that discriminate and choose to openly serve only subgroups or ‘high-functioning patients will be given a mandate by the Office of Mental Health to broaden their scope of services, or they will be subject to a loss of licensing and funding. An example of a programme that only serves a small niche of ‘qualified’ patients includes outpatient settings that refuse to accept state-sponsored insurance for patients who are disabled and reliant on Medicaid and other service dollars. Conversely, treatment centers that offer services to all patients or that are cited for restructuring and successfully reconfiguring their clinics, group practices, and day treatment centers will be awarded funding to commit to on-site projects and community outreach projects to further extend services to the community.

How a brain injury through an accident enabled the help, I deserved but wasn’t getting

Most of my life before I gained the recognition of having the serious mental illness of bipolar was bright, activity-filled, and fulfilling. It was really only a period of less than a year that I can recall where I had symptoms that demanded I see a doctor. Unfortunately, the next 9 years of taking medications and intensely pursuing schoolwork did not bring about much of a recovery that was long-lasting. Although I attended groups at day treatment and was compliant with my medications, my life fell in shambles in the spring of 2007. I had been searching for 4 years starting in 2003 for a treatment that could help my whole sense of being.

I had felt that day programs and cognitive behavioral therapy were not going far enough to help me to return to the self that I recalled from the 80s and 90s. I can say now in 2020 that I clearly recall myself then. In fact, there’s a wealth of emotions, good and bad, that have returned to me more clearly in the past 13 years I have been receiving treatment for my condition- for my brain injury, not for bipolar. There are 2 main doctors I can attribute to major recovery in my sense of self for many years. They are neurologists, not psychiatrists. Neither of these doctors prescribed medications for my bipolar but helped me understand my illness and head injury in the context of my life story. No psychiatrist I have ever had has taken my life story into account and addressed me accordingly.

However, my neurologists have. The past is very important in the context of the brain. With this taken into account, I have been prescribed speech therapy. This helps me restructure my thoughts into patterns that are more clear and easier to describe. My life has become much easier from the addition of this therapeutic since 2016. This is something that could have helped me before I had the head injury. So much of what I was searching for in 2004 has actually been manifested since proper treatment from a neurologist and neuropsychologist.

So why isn’t speech therapy widely recognized as effective for people with serious mental illnesses such as schizophrenia and bipolar? I know in my case that this was only available because of my diagnosis of a traumatic frontal lobe head injury. I have regained some short-term memory, problem-solving skills, and reading comprehension. Those were things that I had wanted for over 10 years, but I was basically told that this person was forever gone. People with schizophrenia-related illnesses often need attention in these areas.

I gained the help of a neurologist in 2015 through self-guided advocacy resulting from constant dizziness in my group home apartment. No one had ever thought of this, despite my visible lack of balance. This took an all-night-long emergency room visit and a referral to an institute that specializes in treating neurological conditions. The referral from a neurologist to a physical therapist for my balance and speech therapists for disorganized thoughts has completely changed my life. I have suffered disorganized thoughts for decades. I guess that disorganization truly Is a symptom of my illness, not just my brain injury. The sense of self I have recovered is mostly possible with neurological treatment. Compliance with psychiatric protocols, but with advocating for my best interests, is also necessary.

I think my story, although tragic at parts, illustrates the need for serious mental illnesses such as mine ( bipolar 1 with psychotic features) to be seen as a whole-brain phenomenon, not simply something that only behaviors can mitigate in therapy. But no one generally goes through things like what I did. I am fortunate to have survived this brush with death. Other people with severe brain illnesses like mine have similar experiences that, like mine, could have been prevented with more cognitive restructuring therapeutics that restore emotional well-being.

Vitor Sallys Story according to His siter Vitoria Sallys

Vitor Sallys Story according to his sister Vitoria Sallys

Brazil has lost its Humanity in the Era of Fascism. Fake news and lies now persist while the vulnerable die by execution, torture, electric shock, and all kind of aggression, physical and psychological, inside psychiatric institutions and so-called Therapeutic Clinics.

Vitor Vinicius Sally was a Brazilian 21-year-old gay man who needed help and support with his many emotional and psychological issues. He Struggles constantly with his sexual orientation because of society’s hatred, ignorance, pressure, and discrimination against gay people. Vitor kept to himself his feelings and fell into substance addiction. His sister told me Vitor’s life history. She told me how Vitor’s death happened. The family is seeking justice, and I am advocating for Vitor’s and his family. They want justice, all involved in Vitor’s death should be held accountable for participating in this heinous crime.

According to Brazilian law 10.216 of 2001, the mental health system brutally violated Vitor’s rights. They neither protect nor respect the law forbids any ill-treatment, action, and discrimination against a person with a behavioral mental health diagnosis. Law 10.216 of 2001 prohibits institutions and individuals from acting or discriminate against people with a history of mental illness. There is also another Brazilian law, 7.716 of January 05 of 1989, that guarantees Vitor’s rights which states that under this law, all crimes resulting from discrimination based on race, religion, ethnicity, prejudice against sexual orientation, and homophobic practice. These two laws did not protect Vitor’s life and neither his rights as a vulnerable person. These violations are punishable by two years in prison.

Five years ago, young Vitor Vinicius Sally’s mother had to commit him to a psychiatric institution for drug misuses treatment, Nina Rodrigues hospital of Sao Luis, MA. After three days in the Nina Rodrigues Hospital, he was transferred into the Neuropsychiatry clinic of São Francisco. Right after Vitor and his mother arrived at the Sao Francisco Clinic, the clinic’s psychiatrist and a nurse told Vitor’s mother that she could not stay with her son and that her presence in the facility would only interfere with his recovery. However, the clinic staff told the Victim’s mother that she could come back to visit him after 15 days.

Vitor’s mother could not wait 15 days to see her son, so she went to the clinic several times to see her son, she tried to look at him even if was from a distance, but her effort was in vain she was never able to see him because the clinic staff would not allow her to see her son. They refused to let her in to see him. After 15 days, Vitor’s mother returned to the clinic. Upon arriving there, one of the nurses said it would not be possible for her to visit her son because, according to them, Vitor was doing very well, and he even gained some pounds. He has even become a little bit chubby. If she saw him, she would be interfering with her’s son treatment and recovery.

Vitor’s mother feeling powerless, cried and begged them to let her see her son, even if she could not speak to him. She won’t see him from a distance. She even promised the clinic staff that if they let her see him, she would leave and would not let him know that she was there. So once more, the clinic staff did not allow her to see her son, not even from far away.

Vitor’s mother did not give up seeing her son, so she walked around the clinic outside to see if she could see Vitor, but unfortunately, all her effort was in vain. Again, she couldn’t see Vitor. Three more days passed in a total of 18 days that he had been in Sao Francisco Clinics. The Victim’s sister said, “They called our neighbor saying that my brother was very sick at the hospital of Socorro II. Saying that he had pneumonia, they fabricated all kinds of lies to justify their crimes.”

When the Victim’s mother arrived at the public hospital Socorrao II, in the emergency room, “everyone there was already aware that she was the mother of the boy who had was admitted there already lifeless. They tried to make a fool of my mother. When she arrived at the hospital around 6:30 pm, they all denied that he was there. Only around 10-pm did my mother locate my brother’s body”.

“All of Socorrao’s staff nurses told my mother that Vitor wasn’t there.” The Victim’s mother kept looking for her son from 6:30 pm to 10 pm. Even the hospital’s doorman told Vitor’s mother that her son was not there while she was looking for him all over the hospital. Finally, the same doorman of the hospital, seeing my mother there at 10 pm, still unable to find Vitor, told my mother to speak with a specific nurse who would tell my mother where she would discover Vitor.

“The nurse tried to brainwash my mother’s head, telling lies after lies after lies about my brother’s condition. She even told my mother that my brother had been involved in a fight with the other patients. She also said that my brother had suffered two cardiac arrests. He had died of pneumonia. She then said that the hospital had done everything they could to save my brother’s life, telling my mother that he had been in the ICU, the operating room, then in the infirmary. After that, he passed away.

“My mother was in such distress when hearing that my brother was dead, that she got to the point that she was carried by one of our neighbors who had gone there with her”. She was carried by one of our neighbors who had gone there with her”. When reaching the morgue, she opened the black bag in disbelieve at what she was seeing in front of her.

My brother’s body was badly beaten with black eyes, broken nose, broken teeth, broken ribs, one arm broke, the other arm was purple with electric shocks from top to bottom, his toenails were ripped off, his private parts full of marks of electric shocks. My mom said that “his head looks like that was a smash because it was all sawed up with stitches.” My mother said that he already had a rotten smell. They couldn’t even say that he was already dead when he was admitted to the hospital.

“We buried Vitor”, said his sister, “We gave interviews to all the newspapers in the state of Maranhao. We held a demonstration in front of this clinic. While we were doing the protest, my mother could come in to talk to the psychiatrist who admitted my brother. The first day that he got into the clinic before her son was killed. My aunt came in and spoke to her. The other clinic staff told their version about what had happened to Vitor.

“The psychiatrist even had the nerve to say to my mother and my aunt they were silly and dramatic about Vitor’s death. The psychiatrist of Sao Francisco Clinics said that “Whatever they were doing would not bring Vitor back from the dead.” Vitor’s mother replied to the psychiatrist, saying, ‘No matter what happened inside the clinic, that was not a justification or reason to rip his toenails, electrocuted his private parts, break his ribs, break his teeth, his arms and head’. Vitor did not deserve to die, and even worse the mental health system dehumanized him in the ways his body was left and what was done to him. After the brief conversation, the psychiatrist told Vitor’s mother, ‘Oh, but he was gay, and he had HIV.’ She was implying that what they did to him was because he was gay.”

Vitor’s sister asked me if this was why they tortured him. Did they do that to his body because he was gay, and he had HIV?

“Is that really the reason why they kill my brother? These were no reasons for the clinic’s staff to mutilate his body and electrocuted his private parts for any reason? They killed him and they never gave us the test with the AIDS results. I don’t even know if he had HIV. Now I wonder what about the others who suffered there and the others who are still at risk of losing their lives inside that clinic. Will they die too?

“You know, various former Sao Francisco Clinic’s staff, after Vitor’s death, came by to our home and told us that the patients in the clinic are denied food, water, clothes, they sleep on the floor, and women are full of lice. They let the patients have intercourse with the male participants. They beat the patients. There is no breakfast, only coffee in the morning for everyone. There are no female personal hygiene products. Everything is dirty. There are no mattresses, so the patients sleep on the cold floors. When they asked to speak with their families, the Clinic staff would not allow them to make a phone call.

“According to former staff of the Sao Francisco Clinic of Neuropsychiatric, the patients in the clinic are mistreated and dehumanized by the institution. Vitor’s family stated that during the demonstration, for justice, some of the clinic staff were leaving the facility with attitudes that indicated no remorse for what they had done to Vitor. Upon leaving the clinic’s grounds, the psychiatrist who looked at Vitor’s mother and threw a kiss over her shoulders and started to smile at Claudineide Sallys.” Vitoria said, “It looks like she was mocking our pain.”

Vitoria told me that while her brother was hospitalized in the Sao Francisco Clinic, “My mother would take fruit, clothes, a towel, toiletries, a new slipper, for her brother, but he never got any of these items. And yet, he still died in an old slipper with a hairpin underneath.” She explained to me that “the lawyer we had handling Vitor’s case, he initially was interested and told us that would be easy to win my brother’s case.

“However, suddenly, the lawyer went missing for about a year. Later, he showed up and told us that Vitor’s case was not a winning case. To make things worse, we didn’t have any more news about Vitor’s medical report that was supposed to get in a month. We could only get it after a year. Vitor’s horrifying death in the medical reports only states that his violent death was only bacterial pneumonia.”

Vitor’s sister says, “My brother had suffered so much while he was alive. He was humiliated and tortured. To make things worse, they only delivered his body to us in states of putrefaction. Yet, they are still claiming that he had just died in the emergency room. He was being beaten day and night and killed as the result of these beatings, he was tortured to death, and nobody helped us get justice.

“The Socorro staff and the media later had the nerve to tell us that Vitor passed away from an acute infection and did not explain his broken body and the signs of torture. Some former clinic staff told us that inside this Sao Francisco clinic is a hell on earth, and they asked not to mention their names as they are afraid of threatens, intimidation, and being murdered.”

Vitoria said that “My mother and I want justice. It’s been five years since Vitor’s death, and nothing has been done about it”.

She mentioned that she could only imagine the ill-treatment inside the clinic in question remains the same as before her brother’s murder. According to her, “These abuses continue to take place daily. The inhumane treatment continues to happen, and nobody has done anything to stop it. My brother was not the first to be killed there. I am quite sure that he will not be the last.” Vitoria says. She tells me that she wants justice to be served. These slaughterhouses shut down for good. To conclude this narration, Vitoria says that “Her brother’s body has gone missing from the place where he was lied to rest. To this day, nobody knows where the body is. The suspicious fall over the Sao Francisco Clinic, but there is no proof (Vitoria).

We all asked these questions:

Why was Vitor tortured to death?

Was it because he was gay?

Was it because they suspected he had HIV?

Healthy fascinations went awry

With thoughts moving at breakneck speed, at 16, I did not see an end to the downward spiral. I was on a band trip with my high school in the nation’s capital. In 1998, I was without sleep for at least 14 straight days. The antics of my hotel roommates were no solace for the turmoil I found myself in. The Greyhound took me and the high school band from place to place- from The Lincoln Memorial to the steps of the Washington Monument. I shot pictures of friends that must have been lopsided.

I was clearly out of focus. What would have been a joyful experience was tainted by moods which confused fear with joy. I had spent the whole spring before this trip exploring the local woods, sometimes as early as the break of dawn, sometimes while barefoot. My healthy fascination with the sunrise had become an obsession, as I started to lose sleep to catch the sunrise regularly in the summer of 1997. I was manic and psychotic. The nurses and doctors at the hospital caught it upon my dramatic admission in late April 1998. Immediately the staff thought that I had been traumatized while on the school trip.

Due to my rapidly moving thoughts, the staff Immediately administered the antipsychotic Haldol. In drama club, track. and wrestling, people had admired me for my speed and energy. However, These were telltale signs of my mania, not caught until guided inside the hospital emergency room. The first referral was my pediatrician to a psychologist, then the hospital emergency room due to the urgency of the situation, It was hard to know where to go since things were so sudden, and in the 1990s, mental health was rarely discussed.

Throughout my week’s worth of no sleep in Washington DC, terror was rampant. I hurt myself for the first time arriving home from this trip but caught myself before going too far. The newer generation antipsychotic Zyprexa administered in the controlled setting of the hospital allowed my foggy thoughts to meaningfully coalesce. After a week or so, the real game-changer was making art with chalk pastels in occupational therapy. My brain cells rewired, creating original natural scenery during discussions with others in the unit. Healing occurs naturally in the arts, and in my life, Medicine is secondary.

To this day I make art, with occupational therapy on the psychiatric unit as the precedent. The psychosis WAS the substance of my art. My subconscious came to life in the throes of confusion. Elusive Figures from my past have come alive with poetry and storytelling in artistic expression. Songs on guitar have expressed romantic adventures and provided entertainment to crowded nightclubs. As I recount dramatic stories with creative expression, a new life takes shape.

Human Rights Coalition for Latin America Mental Hygiene & Social Justice

The human rights of the mentally ill are violated in Brazil every day. The crimes continue without end. I am writing to introduce Dr. Marcelo Henrique, the founder, and CEO of OBDH.

Dr. Marcelo Enrique has a long history of human rights activism in Brazil. He is a scholar, a lawyer, an advocate for social justice, and a strong voice for public health reforms. He and his colleagues created the institute of The Right of Defense to assist judicially the incarcerated population and those with behavior mental health history behind bars. In addition to being a lawyer, Dr. Marcelo has written articles and a book about Human Rights and Health Accessibility in Brazil (Directions Humanos e Accesso a Saude No Brazil). He is also the founder and the CEO of OBDH, the Humanitarian Organization that judicially helps and supports the less fortunate Brazilian population. Through the OBDH professor, Marcelo and his colleagues have been helping a lot of people throughout Brazil.

OBDH is an organization that juridically helps and supports the less fortunate Brazilian population and the rights of people being violated and tortured just because of their mental illness. At the root of it, OBDH is a human rights organization fighting for Social Justice, Helping the less fortunate, Educating for Justice, and Advocating for Reform for the Public Health system.

It was an honor to attend the live session on August 12, 2021, hosted by the OBDH, a Brazilian non-profit organization fighting for Human Rights in Brazil. The OBDH (Observatorio Brasileiro de Diretos Humanos) have been working intensively ever since its creation helping and supporting all Brazilian people who at present are in great distress.

Max E. Guttman, LCSW, was one of the guests of honor of the live broadcast. He shared his experiences and insights into mental health systems and the treatment of mental health disorders. He spoke on how different Brazil and the United States are regarding their treatment of people with mental health diagnoses.

“The disparities are staggering, and the need to globally address this crisis is more urgent than ever,” Mr. Guttman commented on the crisis plaguing Brazil and much of South America.

I was very proud to be part of this event. I am also looking forward to contributing more to OBDH. For this reason, I have created a virtual group that aims to work with many American professionals. Each professional assists and supports, helping alleviate the pain and the suffering of the Brazilian population by sharing their expertise and work experience to help save lives in the South American nation.

Brazil is in crisis, and people with behavior mental and dual diagnoses are facing great peril. These people are marginalized and treated like animals are considered dangerous people to Society in the South American Nation. According to Blogs like G1, O Cubo, Maranhao do Povo, and others, this population has published the atrocity that these populations are suffering. The Brazilian news has shown the lack of humanity toward this particular community. These populations are subject to oppression and discrimination. They are being raped, tortured, and starved to the brink of death.

People are in cages!

Thirty-three women in Ceara in Crato, Brazil, were kept imprisoned in small enclosures that are no different from human cages. People killed inside Brazilian psychiatric institutions. 21-year-old Vitor Sally was found dead inside the Clinic Sao Francisco with ribs, broken arms, and teeth.

In the spirit of seeking justice for the marginalized community, I have created the Human Rights Coalition for Latin America Mental Hygiene & Social Justice with one of my colleagues.

This social justice group’s mission is to create awareness about the uncountable Human Rights Violations against the most vulnerable populations living with due diagnosis (Mental Health Disabilities), forensics issues, and Gender-Based Discrimination and Violence in Latin America, especially Brazil. We aim to create a coalition with a diverse group of professionals with expertise in different fields to assist and support our voluntary work. Brazilian and American bloggers who have published Vava history, Francisco history, Vitor Sally history.

We are standing up for justice and humanity.

Cases in which families have experienced their relatives tortured and killed by Therapeutic Clinics in the country. Vitor Sally’s case, a 21-year-old young man, had his body broken, mutilated, and his private parts electrocuted. All while inside a psychiatric clinic for substance misuse treatment.

Vava’s case (Jose Vandeilson Silvina de Sousa) was a 17 years old boy denied help when he had a mental health crisis—mistaken for a person who was drug-addicted and not a teenager who was having psychosis. He went missing for ten months.

And the-less fortunate, Francisco Osvaldo, like Vitor Sally’s, was a victim of the same Clinic that Vitor Sally was killed five years early( according to Vitor’s relatives’ story). Francisco, too, suffers ill-treatment due to the torture and starvation he was forced into while inside the clinic for treatment for his Bipolar disorder. When delivered to his family, Francisco was very feeble, disoriented, and with an abnormal belly. Three days later, he passed away. Therefore this great scholar is doing all these work free of charge to the victim’s family.

One of his earliest works in the country is where he and his colleagues created the entire SUS diabetes protocol designed in the light of regional actions, cooperation, and the partnership that Dr. Marcelo made with the Federal Public Ministry.

Through the work of Dr. Marcelo and his friends who believe in his career and together with his many friend and supporters, the OBDH was created on February 20, 2021. The day of Social Justice.

Before creating OBDH, Dr. Marcelo Enrique and his allies and friends worked to charter the Principle for the Rights of Children and Adolescents with Type I Diabetes. The entire SUS protocol was designed and created by him and his allies and friends. This cooperation & partnership was signed between him and the Attorney for Citizens’ Rights, at that time under the command of Dr. Jefferson Aparecido Dias.

The Brazilian Observatory of Human Rights is the light and beacon of hope for many Brazilians. The Brazilian Observatory of Human Rights’ primary mission is to alleviate Brazilians’ pain, suffer, support, and help the less fortuned judicially throughout Brazil. The organization operates, offering its services to all with no cost, totally free of charge. OBDH never asked anybody for a financial contribution.

As I continue to learn about his work, Dr. Marcelo has a long history of humanitarian work. He has been doing this for a long time throughout the country, helping the vulnerable groups and the underserved, marginalized population in the Brazilian Society.

This article commemorates his achievements.

Category: Systems IssuesCategory Archives:

Solid Ground and the Rescue Line

Like this:

The Communication and Support That Allows Progress in Treatment

Like this:

RESPONDING TO A MENTAL HEALTH CRISIS: WHO IS THE MOST QUALIFIED?

Like this:

This is a PRO Tobacco Use Argument in Mental Health Settings

Like this: